Gastric Bypass Surgery as a Last Resort
Carnie Wilson and Al Roker have popularized gastric bypass surgery as an effective way to lose weight. What better advertisement for obese teens than celebrities whose before and after images can't be ignored? But Wilson and Roker underwent the surgery as adults. Is it safe for teenagers?
"The data in the medical literature shows that weight loss surgery is as safe in teenagers as in adults," says Dr. Milton Owens, director of the Coastal Center for Obesity at Chapman Medical Center in Orange, Calif.
But it's still surgery. "It's never safe," says Keith Ayoob, a registered dietician speaking on behalf of the American Dietetic Association. "It's drastic surgery that is used only when all other reasonable methods have failed."
Our Growing Children
What's not in dispute is the epidemic of obesity in children and adolescents. According to the National Center for Heath Statistics, about 15 percent or nine million Americans between the ages of 6 and 19 are overweight. This data, cited from 1999 and 2000, is triple the number from 1980.
For many teenagers, gastric bypass – also known as stomach stapling – is the method of last resort. By reducing the stomach's capacity to hold food, people who are severely obese can finally shed their weight. It's not an easy process, and it's even more complex for those of a younger age.
Dr. Louis Flancbaum, chief of bariatric surgery at St. Luke's-Roosevelt Hospital Center in New York City, has performed gastric bypass on a number of teenagers. "Most surgeons agree that a teenager should have stopped growing (reached mature bone-age) before having surgery, which probably means 15 to 16 years old," he says. "In addition, I believe the teenager must be able to give informed consent (understand what the operation does and the permanent changes it will produce), the parents need to be on board and will provide an appropriate environment for success (cooking appropriate meals, etc.), and that a mental health evaluation be done."
While there are no long-term studies, Dr. Owens says there is a fairly large number of adult patients 20 years post-surgery who do not seem to be having any particular problems. The surgery's dangers are not to be minimized, however. The risks range from electrolyte imbalances to heart failure, liver problems, premature osteoporosis and chronic diarrhea. Compare that to the impaired self-esteem, depression and health risks that come with being extremely obese.
"Surgery for weight loss in severely obese teenagers is clearly preferable to no or inadequate weight loss," says Dr. Owens. "In addition to the dangerous medical effects of obesity, obese teenagers are stigmatized by their peers more severely than adults and suffer long-term psychological effects. Hence, the longer term potential for undesirable side effects from surgery must be weighed against the emotional damages a teenager sustains from being severely obese."
And for females, losing the weight now can positively impact a teen's life later. According to Dr. Owens, losing the weight improves fertility and decreases the likelihood of problems with labor and delivery.
The Right Time
When should teenagers consider gastric bypass as an option? Dr. Owens says when they are roughly twice their normal body weight or in the top 5 percentile in weight. Less heavy teenagers with serious complications of obesity might be surgical candidates also.
"Although there is little evidence that significant weight loss can be achieved and maintained without surgery [for those who are severely obese], teens considering surgery should have made at least one serious effort to lose weight without surgery," says Dr. Owens. "Also, they should be willing to make a similar serious effort afterward, as surgery alone does not guarantee good, long-term weight loss."
Undergoing this procedure means a drastic change in lifestyle. The teenager's personality will undoubtedly change. Attitudes toward food, eating and body image will have to improve. A mental health therapist is often helpful in assisting the teen in making this transition. Family support is also critical, especially since relatives have to be willing to change the eating environment at home.
A True Story
Gastric bypass changed everything about Irene Orr's life. Now 21, the resident of Anaheim, Calif., had the surgery at age 19. She had tried many diets without results. She saw a doctor and nutritionist. Nothing worked. "I was tired of living my life as a prisoner in my own body," says Orr.
Orr had the same concerns as critics of the procedure. But she gave her decision a lot of thought. "I weighed the long-term effects of remaining 350 plus pounds for the rest of my life including: sleep apnea, diabetes, high blood pressure, joint problems, even death," she says. "I realized that no matter the long-term effects of the surgery, my other option was just not worth it. I would rather be young and happy than be worrying about what the possible side effects are. Nothing can be worse than dying."
Orr also worried that people would look at her and say she took the easy way out. Some of her family members even thought this. "Because it is such a drastic procedure that many do not understand, I was worried that I still wouldn't be treated with respect," she says. "I also worried that I would lose the weight and then eventually put it back on."
Now that she's had the surgery, Orr says it is definitely not an easy way out. The way she eats, moves and exercises have all changed. Every day for the rest of her life, she has to take vitamins to ensure that she's getting all of the proper nutrients. She has to exercise regularly and do her part to make sure the weight stays off. Her only regret is that she did not do it sooner. And her response to critics is "Try being 350 pounds in high school and see how you feel."
"Why deny a 360-pound or more 15-year-old a chance at a normal life with normal longevity by having a proven therapy when there isn't a shred of scientific data to suggest that diet, exercise, behavior modification and drugs can be effective [for the extremely obese]?" asks Dr. Flancbaum.
Two years after the surgery, Orr weighs 161 pounds. She has a whole new lease on life. "It was the best decision I've ever made," she says.